Journal of Telemedicine and Telecare最新文献

Introduction: This study aimed to determine the efficacy of telerehabilitation for patients after hip fracture surgery through a systematic review and meta-analysis.

Methods: Eight electronic databases were searched in August 2022. The primary outcomes were mobility outcomes, activities of daily living (ADL) outcomes, and all adverse events, whereas the secondary outcomes were pain, health-related quality of life, and fall efficacy scale score.

Results: Seven randomized controlled trials were eligible for this study. The evidence regarding the effect of telerehabilitation on mobility outcomes (standardized mean difference (SMD): 0.05, 95% confidence interval (CI): -0.39 to 0.48) and all adverse events (risk ratio: 1.14, 95% CI: 0.62 to 2.21) was very uncertain. A clinically irrelevant but significant mean difference (MD) in ADL outcomes was found (MD: 4.82, 95% CI: 2.63 to 7.01). Telerehabilitation may result in a slight increase in fall efficacy scale score (SMD: 0.26, 95% CI: -0.02 to 0.54) and little to no difference in pain (MD: -1.0, 95% CI: -18.31 to 16.31).

Conclusions: The efficacy of telerehabilitation for patients after hip fracture surgery was uncertain with respect to the mobility outcomes, all adverse events, and pain, with no clinically meaningful differences in ADL outcomes. Telerehabilitation may be necessary to be considered for patients after hip fracture surgery to improve their confidence in their ability to perform daily activities without falling. Therefore, medical staff may consider telerehabilitation for hip fractures.

Despite evidence to the contrary, U.S. policy makers, payers, and the public continue to express apprehension that the use of telehealth is associated with increased risk of fraud and abuse. The fraudulent use of telehealth is multifaceted and complex, ranging from potentially false claims to miscoding, inaccurate billing, and kickbacks. For the past 6 years, the U.S. Federal Government has undertaken research studies to examine potential fraud issues related to the use of telehealth, including up-coding time spent with the patient, misrepresentation of the service provided, and billing for services that were not rendered. This article reviews previous efforts to assess the risk of fraud associated with the delivery of virtual care in America, concluding that there is little evidence for higher levels of fraud and abuse related to the use of telehealth.

Introduction: Patients with systemic lupus erythematous were vulnerable to severe coronavirus disease 2019 infection and the negative impact of disrupted healthcare delivery. Telemedicine has been a popular alternative to standard in-person care during the pandemic despite the lack of evidence.

Methods: This was a 1-year pragmatic randomized-controlled trial. Patients followed at the lupus nephritis clinic were randomized to either telemedicine or standard follow-up in a 1:1 ratio. Patients in the telemedicine group were followed up via videoconferencing. Standard follow-up group patients continued conventional in-person outpatient care. The primary outcome of the study was the proportion of patients in low disease activity after 1 year. Secondary outcomes included cost-of-illness, safety, and various patient-reported outcomes.

Results: From 6/2020 to 12/2021, 144 patients were randomized and 141 patients (telemedicine: 70, standard follow-up: 71) completed the study. At 1 year, 80.0% and 80.2% of the patients in the telemedicine group and standard follow-up group were in lupus low disease activity state or complete remission, respectively (p = 0.967). Systemic lupus erythematous disease activity indices, number of flares and frequency of follow-ups were also similar. There were no differences in the cost-of-illness, quality of life or mental health scores. However, significantly more patients in the telemedicine group (41.4% vs 5.6%; p < 0.001) required switch of mode of follow-up and higher proportion of them had hospitalization during the study period (32.9% vs 15.5%; p = 0.016). Being in the telemedicine group or not in low disease activity at baseline were the independent predictors of hospitalization (odds ratio: 2.6; 95% confidence interval: 1.1-6.1, odds ratio: 2.7, 95% confidence interval: 1.1-6.7, respectively) in the post hoc analysis.

Conclusions: In patients with systemic lupus erythematous, telemedicine predominant follow-up resulted in similar 1-year disease control compared to standard care. However, it needed to be complemented by in-person visits, especially in patients with unstable disease.

Introduction: Teledentistry is an innovative health care delivery platform that can potentially improve oral health access and outcomes. The purpose of this study was to predict teledentistry utilization intentions of U.S. adults using the Unified Theory of Acceptance and Use of Technology (UTAUT) as a framework.

Methods: This mixed-method, cross-sectional study surveyed 899 participants from two independent samples in August and September 2021. Convenience samples of Minnesota State Fair attendees and ResearchMatch volunteers completed electronic surveys to identify the behavioral intention (BI) for teledentistry use within the next 6 months. Independent variables were the UTAUT constructs of performance expectancy (PE), effort expectancy (EE), social influence (SI), and facilitating conditions (FC). Data were analyzed using univariate analysis and multiple linear regression adjusting for age, gender and educational level. Qualitative analysis used thematic analysis using UTAUT as a coding framework.

Results: Univariate analysis showed statistical significance between each construct with BI (P < 0.0001). Adjusted multiple linear regression revealed statistical significance between PE and SI with BI (P < 0.0001). Qualitative responses corroborated quantitative results and revealed a lack of teledentistry knowledge.

Conclusion: The majority of participants indicated an intention not to use teledentistry within the next 6 months. The lack of prior experience of telehealth or teledentistry use in addition to lack of knowledge regarding teledentistry may contribute to these results. Future interventions to improve the BI to use teledentistry may benefit from focusing on PE and SI constructs for educational and marketing strategies.

In this case report, we describe the performance of procedural sedation and emergent joint reduction via remote telehealth leadership for a patient with an acutely limb-threatening injury. The patient was a 33-year-old man who presented to a small rural hospital with a fracture dislocation of his ankle complicated by severe pain refractory to opiate analgesia and neurovascular compromise, including absent peripheral pulses and sensory changes. Due to aviation and resource limitation factors, immediate retrieval was not possible. While it was clear he needed urgent treatment, local staff expressed that they did not possess the training or requisite experience to undertake a procedural sedation and joint reduction. Following extensive discussions between the telehealth specialist and the local team, the telehealth doctor assumed clinical governance for the case, serving as team leader and coaching the local team through a ketamine procedural sedation and emergent joint reduction. Ultimately, these procedures were successful, with immediate improvement in limb neurovascular status. This case, along with prior work, demonstrates that High-Acuity Low-Occurrence (HALO) procedures can be facilitated by telehealth. Key learning points from the case include the choice of anaesthetic agent given limited local experience, delegating a separate telehealth clinician to monitor patient vital signs to cognitively offload local staff, and the importance of detailed pre-procedure discussions prior to completing HALO tasks.

Introduction: Mental health issues disproportionately affect rural and low-income populations, where access to prevention and treatment is limited. Implementing telemental health services (TMHS) in Federally Qualified Health Centers (FQHCs) could improve accessibility to mental healthcare. This study assessed the effect of TMHS on mental health services utilization in FQHCs, comparing centers with and without TMHS and examined differences in TMHS effect between FQHCs that adopted TMHS before and during the pandemic.

Methods: The study utilized FQHC-level data from Uniform Data Systems annual performance reports (N = 9540 FQHC-year) and county-level demographic, health status, and provider characteristic data from 2016 to 2022. A two-way fixed effects model was applied to examine the effect of TMHS on mental health visit rates, supplemented by the Sun and Abraham difference-in-differences estimator. The analysis included both pre-COVID and during-COVID TMHS adopters.

Results: FQHCs offering TMHS showed 1.04 times increase in overall mental health visit rates compared to those without TMHS. Centers serving higher proportions of Medicaid-insured (1.07 times) and low-income (below 200% FPL; 1.05 times) populations showed even higher visit rates. During-COVID TMHS adopters showed a significant increase (1.05 times), particularly in urban areas, whereas rural adopters did not see significant changes.

Conclusion: FQHCs offering TMHS showed increased mental health visit rates, especially among low-income and Medicaid-insured populations. FQHCs that adopted TMHS during the pandemic experienced a marked rise in mental health visits, but rural-urban disparities persist, highlighting the ongoing challenges in expanding access to mental healthcare in rural settings.

Introduction: Optimal hospital bed utilization requires innovative patient care models. We studied a novel hospitalist model utilizing telemedicine to facilitate collaboration with affiliated emergency departments (EDs) and support medical triage and care of ED patients with high likelihood of hospital admission.

Methods: Telehospitalists based at a tertiary care facility collaborated with four community EDs in the same healthcare network between January 1, 2022, and April 30, 2023. Telehospitalists supported ED clinicians in medical care decisions and facilitated patient disposition. Emergency department length of stay (LOS) and disposition were evaluated, as were hospital LOS, 30-day readmission, and in-hospital mortality. For patients discharged from the ED, 7-day ED readmission and subsequent hospitalization were evaluated.

Results: Telehospitalists discussed 550 "admit-likely" patients with ED clinicians: 105 patients (19.1%) discharged from the ED and avoided admission; 322 patients (58.5%) were admitted to local or nearby community hospitals; 123 patients (22.4%) transferred to the tertiary care facility. Emergency department LOS differed significantly among disposition groups, including patients discharged home (10.2 h), admitted to local hospitals (12.6 h), and transferred to tertiary care hospitalist services (14.9 h; p < 0.001). Hospital LOS and in-hospital mortality were not significantly different among disposition groups. Patients admitted locally had lower 30-day readmission compared to those transferred to tertiary care facility (odds ratio = 0.59 [0.36, 0.99], p = 0.048).

Discussion: Telehospitalists as triage clinicians is an innovative approach to support local ED clinicians and patients. Telehospitalists optimized hospital bed utilization and healthcare system resources by facilitating safe discharges to home and expediting tertiary care transfers when necessary.

Objective: We aimed to examine the associations of telepsychiatry consultations with the Medicare Benefits Schedule (MBS) telehealth policy changes (pandemic-related expansion and subsequent consolidation).

Methods: We performed a time series analysis of MBS telepsychiatry usage (January 2016-December 2023) using state/territory-level Medicare panel data. Linear regression analyses with panel-corrected standard error and autocorrelation were performed for telepsychiatry consultations (overall and age and sex subgroups). Telehealth policies, rural psychiatrist availability (rural psychiatrists per 100,000 population) and their interaction were the independent variables. The models were adjusted for pandemic lockdown severity (Stringency Index) and population size.

Results: Telehealth expansion and consolidation were associated with substantial increases in telepsychiatry consultations, with larger increases in the consolidation phase. Given the telehealth policy changes, lower per capita rural psychiatrists were associated with more telepsychiatry consultations. Males and older people (>65 years) showed greater relative consultation increases. Policy change-related telepsychiatry increases varied amongst states and territories.

Discussion: There was sustained telepsychiatry usage when it became more readily available, beyond the direct impact of acute pandemic lockdowns. Telehealth-enabling policies may contribute to fulfilling unmet mental health needs and improving access to psychiatric care amongst Australians. Further in-depth research in this area is needed.

Introduction: Trauma-focused evidence-based psychotherapy (EBP) is the recommended treatment for post-traumatic stress disorder (PTSD). During and after the COVID-19 pandemic, veterans began to initiate general mental health services delivered via video telehealth at high rates. Our goal in the current project was to describe the percentage as well as the demographic, military, and clinical characteristics of veterans receiving PTSD EBPs via video telehealth versus in-person.

Methods: Using data from the VA electronic health record, we identified a national cohort of all-era veterans who received individual PTSD EBP between April 2022 and April 2023 (n = 24,447). We used multivariable hierarchical Bayesian logistic regression to model the probability of receiving at least 50% of their EBP care via video telehealth.

Results: In our sample, 74.4% of veterans who received PTSD EBP used video telehealth for at least one EBP session and 66.8% of veterans received at least half of their EBP sessions by video telehealth. Female veterans, younger veterans, and veterans with fewer mental health comorbidities were more likely to have received their PTSD EBP via video telehealth. Additional strong interaction effects for Black female veterans, Hispanic female veterans, female officer veterans, and Black officer veterans.

Discussion: Video telehealth delivery of PTSD EBPs was more common than in-person delivery of PTSD EBPs. Consistent with underlying trends in telehealth services, female veterans, and particularly female, racial/ethnic minority veterans were more likely to receive PTSD EBP via video telehealth. Future research designed to contextualize the observed differences in video telehealth delivery of PTSD EBPs should consider the role of social determinants of health.

Objective: To evaluate whether, in patients with trauma and soft tissue injuries of the wrist, hand and/or fingers, an exercise program performed on a touchscreen tablet-based app reduces the consumption of face-to-face resources and improves clinical recovery, compared to a conventional home exercise program prescribed on paper.

Design: Pragmatic, multicentre, parallel, two-group, controlled clinical trial with blinded assessor.

Participants and setting: Eighty-one patients with traumatic bone and/or soft tissue injuries of the hand, wrist and/or fingers recruited in four hospitals of the Andalusian Public Health System.

Interventions: The experimental group received a home exercise program using a touchscreen tablet application and the control group received a home exercise program on paper. Both groups received the same treatment of face-to-face physiotherapy.

Primary outcome: Number of physiotherapy sessions. Secondary outcomes were the duration of physiotherapy and clinical variables such as functional ability, grip strength, pain and manual dexterity.

Results: The experimental group required fewer physiotherapy sessions (MD -11,5 sessions; 95% CI -21.4 to -1.4), showed a shorter duration of physiotherapy (MD -3.8 weeks, 95% CI -7 to -1) and had better recovery of grip strength, pain and dexterity compared to the control group.

Conclusions: In patients with trauma and soft tissue injuries of the wrist, hand and/or fingers, an exercise program performed on a touchscreen tablet-based app in combination with face-to-face physiotherapy reduces the consumption of face-to-face resources and improves clinical recovery, compared to conventional home exercise program prescribed on paper.